储袋外科并发症及不典型增生的临床诊疗  

Diagnosis and management of surgical complications and dysplasia related to the ileal pouch

作　　者：练磊[1] 谢明颢 沈博 Lian Lei;Xie Minghao;Shen Bo(Department of Colorectal Surgery,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Department of Gastroenterology,Columbia University in the City of New York,New York 10027,USA)

机构地区：[1]中山大学附属第六医院结直肠肛门外科,广州510655 [2]纽约市哥伦比亚大学消化内科,美国纽约10027

出　　处：《中华炎性肠病杂志（中英文）》2021年第2期125-129,共5页Chinese Journal of Inflammatory Bowel Diseases

基　　金：白求恩·爱惜康卓越外科基金(HZB-20190528-5)。

摘　　要：全结直肠切除(TPC)+回肠储袋肛管吻合术(IPAA)是目前外科治疗难治性溃疡性结肠炎(UC)、UC合并癌变以及家族性腺瘤性息肉病的标准术式。然而,IPAA术后可能出现一系列与储袋相关的外科并发症,如吻合口漏、储袋狭窄和储袋瘘管形成等,这些并发症在临床诊断和治疗上具有特殊性,错误的诊断和不当的治疗往往会导致储袋失败而需转行永久性造口。而储袋不典型增生是发生储袋内癌变的高危因素,如不及时发现和处理则有可能造成癌变。因此,充分认识储袋术后外科相关并发症及储袋不典型增生,对其作出明确的诊断和及时的处理有助于提高手术成功率,改善患者预后。本文就目前储袋手术外科并发症及不典型增生的诊断和治疗进展进行总结和论述,以供参考。At present,total proctocolectomy(TPC)and ileal pouch-anal anastomosis(IPAA)is the standard surgical treatment for patients with medically refractory ulcerative colitis(UC),UC combined with carcinoma,and familial adenomatous polyposis.However,there may be a series of surgical complications related to the pouch after IPAA,such as anastomotic leakage,pouch stenosis and pouch fistula formation.There are specificities in clinical diagnosis and treatment for these complications.The wrong diagnosis and improper treatment can lead to the failure of pouch and the switch to the permanent stoma.The dysplasia of pouch is a high-risk factor for carcinoma.And it may become carcinoma,if not detected or treated in time.Therefore,based on complete understanding of the surgical complications and dysplasia related to pouch,a clear diagnosis and timely treatment will help to increase the success rate of surgery and improve the prognosis of patients.This article summarizes and discusses the current progress in the diagnosis and treatment of surgical complications and dysplasia related to pouch for reference.

关 键 词：储袋 并发症 不典型增生 全结直肠切除 回肠储袋肛管吻合术 吻合口漏 储袋狭窄 瘘管形成 松弛储袋综合征 溃疡性结肠炎 家族性腺瘤性息肉病 

分 类 号：R656[医药卫生—外科学]